Schizophrenia and its Relationship with

ABSTRACT (PSP) scale, World Health Organization-Quality of Life BREF

Introduction: Schizophrenia is a chronic mental disorder (WHOQOL-BREF) and Global Assessment of Functioning (GAF).with disabling symptoms and variable outcome. Outcome is There were 30 patients in each group. All statistical analysisa multidimensional construct that depends on description of was done using SPSS version 20.0 statistical software.clinical and social domains. Symptomatic remission is one such Results: Patients in symptomatic remission were found toclinical domain which can determine the outcome of illness. have better quality of life in personal, environmental and socialAim: The study aimed to assess functional outcome in domains (p<0.01). Their personal and social performance issymptomatic remitted schizophrenia patients compared to significantly better in remission group. The overall functioningunremitted patients in Indian population. was assessed by GAF, was better in patients with symptomatic remission (p<0.001).Materials and Methods: This cross-sectional observationalstudy was conducted at the Institute of Mental Health, Chennai, Conclusion: Symptomatic remission may be a good indicatorIndia. Remitted (symptom free in preceding six months) and of better clinical status, personal and social functioning andunremitted patients were assessed by Positive and Negative quality of life.Symptom Scale (PANSS), Personal and Social Performance

Keywords: Mental health, Quality of life, Social functioning

INTRODUCTION Hence, this study aimed to investigate whether the symptomatically

Schizophrenia is a chronic and severe mental disorder that affects remitted patients presented with better quality of life and socialhow a person thinks, feels and behaves. It affects 1% of population functioning compared to unremitted patients.world-wide [1]. Though it is not a common mental illness, thesymptoms are often chronic and debilitating [2]. MATERIALs AND METHODS The study was a cross-sectional observational study, conducted atOutcome of schizophrenia is determined by clinical variables the Institute of Mental Health, Chennai, India, in the year 2012 for threeand level of social functioning [3]. Severity of symptoms is one months. Ethical committee approval was obtained from Institutionalsuch clinical variable that determines the outcome. Independent Ethics Committee, Madras Medical College. Schizophrenia patientsliving, maintenance of social relationships and employment are who were attending the outpatient department for review were tofew other variables that define social functioning of an individual. be screened randomly for the study. Patients' symptom status wasThese variables are often interlinked. The level of outcome (good, reviewed once in four weeks in review outpatient department. Thoseintermediate or poor) was in part mainly dependent on generosity in patients who were mentioned to be symptom free in preceding sixdefinition of these variables for an outcome study [3]. Thus, a study months, in records were taken for remitted group. Other patientswith lenient definition of symptom status or social functioning found56% of patients to be in good outcome category [4], while a study who were symptomatic in records were considered as unremittedwith stringent definition had 59% in poor outcome category [5]. patients. Thirty consecutive patients who fulfilled RSWG remission criteria formed the first (remitted) group. The other consecutive 30For decades, the major hindrance for comparison of studies patients who did not fulfilled remission criteria formed the secondmeasuring outcome is the non-availability of uniform definition (unremitted) group.of remission in schizophrenia. In the year 2005, the Remissionin Schizophrenia Working Group (RSWG) put forth definition for Inclusion Criteriasymptomatic remission and set specific operational criteria for its Consenting individuals of 18–50 years of age, with diagnosis ofassessment [6]. The criteria consist of two elements: schizophrenia according to International Classification of Diseases-1. A symptom-based criterion: They correspond to eight items Tenth Revision (ICD 10), having clinically stable symptoms since the in the PANSS and these item score should be ≤3 to classify last six months were included in the study. them as remitted. The items are delusions, unusual thought content, hallucinatory behaviour, conceptual disorganisation, Exclusion Criteria mannerisms, blunted affect, social withdrawal and lack of History of any other psychiatric illness, concurrent neurological spontaneity. illness or systemic illness known to impair functioning, any substance2. A time criterion requires remission to be persistent for a dependence in preceding six months were excluded in the study. minimum of six months.It was pointed out, however, that the validity of these criteria and Tools Employedthe relationship to outcome measures required further research [7]. 1. A semi structured proforma for socio-demographic data and

All statistical analysis was done using SPSS version 20.0 statistical [Table/Fig-2]: Comparison of illness parameters. *p<0.05 significant software. Chi-square test was used to compare socio-demographic variables and student t-test (unpaired) for other variables. Level of Mean±SD significance was kept at p<0.05 and highly significant if p<0.01. Outcome Measures p-value Remitted Unremitted

RESULTS WHO-QOL physical 59.47 (10.595) 51.83 (8.579) 0.003**

Income per month was divided arbitrarily with the prevailing WHO-QOL psychological 62.03 (11.874) 57.77 (12.204) 0.175 socioeconomic conditions and the range of income reported by WHO-QOL social 60.97 (10.115) 44.73 (15.373) <0.001** the patients into three groups for comparison. Both the groups WHO-QOL environmental 63.8 (8.475) 42.67 (12.609) <0.001** comprised of males predominantly but no gender difference was PSP Self care 1.87 (0.819) 2.8 (1.031) <0.001** observed between the groups for comparison. There was no PSP Social relationship 1.97 (1.129) 3.1 (0.995) <0.001** significant difference between the groups regarding marital status. There was a significant difference between the groups regarding PSP Useful activities 1.53 (0.973 3.5 (1.432) <0.001**

education, employment and income per month with remitted group PSP Aggression 1.4 (0.621) 2.57 (1.331) <0.001** having better education, employment and income per month [Table/ PSP Total Score 65.57 (9.335) 50 (12.999) <0.001** Fig-1]. GAF 63.03 (8.779) 48.73 (11.176) <0.001** There was a significant difference between groups in duration of [Table/Fig-3]: Comparison of functional outcome. untreated psychosis and total duration of illness. There was no **p-value <0.05 is significant

Group significant difference between groups in age, age of onset of illness,

those who were in remission were found to have better insight in light over predictors of remission [18].their disorder, a higher level of global functioning and functionedbetter with respect to daily living task [15]. CONCLUSIONThe social functioning of remitted group was significantly better Symptomatic remission in schizophrenia is found to have betterthan the unremitted group as measured by GAF and PSP score. outcome in terms of WHO-QOL, GAF and PSP. Early treatmentRemitted group was also significantly better in all four domains of with pharmacotherapy in achieving symptom remission will imp­personal and social performance scale. GAF score of 61 and above rove the functional outcome, reduce the pessimistic view aboutwas found to have mild symptoms or no symptoms/difficulties schizophrenia and when combined with psychosocial rehabilitation[11]. GAF score above 80 was considered as adequate functioning will help better social functioning. Hence, achieving symptomatic[16]. Since none of our sample reached GAF score of 80, a cut off remission should be kept as one goal for attaining recovery. Futureof 60 was chosen for comparison of adequacy of functioning. In studies should analyze the predictors of symptomatic remission andremitted group, 46.66% was found to have adequate functioning factors required for adequate real life functioning.with mild symptoms and only 16.66% was found to have adequatefunctioning with mild symptoms. PSP score of 71 and above was References [1] Perälä J, Suvisaari J, Saarni SI, Kuoppasalmi K, Isometsä E, Pirkola S, et al. Lifetimefound to have mild or no difficulty in social functioning [9]. Only 20 prevalence of psychotic and bipolar I disorders in a general population. Archives ofpercent of remission group was found to have adequate social General Psychiatry. 2007;64(1):19-28.functioning and none in unremitted group. [2] Jobe TH, Harrow M. Long-term outcome of patients with schizophrenia: A review. The Canadian Journal of Psychiatry. 2005;50(14):892-900.Though there was significant difference between the groups, [3] Sadock BJ. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Philadelphia,the measure of adequate functioning in each group was less. A PA: lippincott Williams & wilkins; 2000 Feb. [4] Rabiner CJ, Wegner JT, Kane JM. Outcome study of first-episode psychosis: I.similar finding has been reported in a study where a significant Relapse rates after 1 year. The American Journal of Psychiatry. 1986 Sep.better level of functioning was measured for remitted versus non- [5] Krumm B, Müller S, Weber I, Biehl H, Schäfer M. The Mannheim long-term studyremitted patients. But remitted patients still showed areas with an of schizophrenia. Initial results of follow-up of the illness over 14 years after initial inpatient treatment. Der Nervenarzt. 1995;66(11):820-27.inadequate level of functioning. 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